How Do I File an ERISA Appeal?

Was your group disability insurance claim denied? If the policy is part of your employee benefits (ERISA) package, it’s not like any other insurance policy problem. Your best chance at successfully overturning an ERISA appeal is to work with an experienced ERISA lawyer. Our firm has a long track record of helping people with ERISA appeals to overcome the challenges they face. We invite you to call our firm today at 877-583-2524 to learn how we can help.

Filing an ERISA appeal is not like going to small claims court. The law is complicated, as it combines several different areas of law: insurance law and contracts law. Frankel & Newfield has represented many insurance and business attorneys who thought they would be able to manage an ERISA appeal on their own, only to learn that their professional experience did not give them the tools they needed to win an appeal.

One of the challenges of an ERISA appeal is the extremely strict time limitations of the appeals process. If you should miss the deadline to file an ERISA appeal, even by only one day, you may risk ever being able to take your claim to the next level, which is federal court.

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There have been many ERISA lawsuits focused upon whether or not an appeal should be considered because of time restrictions. Some cases were decided based on whether a federal holiday should be included in the 90 day period when an ERISA claim could be submitted. Others argued about whether or not weekend dates are considered because they are not “business days.”

These arguments over dates may seem frivolous, but they have been successfully used by insurance companies to deny ERISA appeals for disability benefits. This would be a terrible reason to lose monthly disability benefits.

Many ERISA appeals have been denied based on the expiration of the time limit. Claimants do not always succeed. Do not delay calling an experienced long-term disability attorney to review your ERISA denial letter and discuss your options. You are invited to call us at 877-583-2524.

All the while, the clock is ticking on your ERISA appeal.

During this limited period of time, a person who is attempting to battle the large insurance companies for their ERISA disability benefits will also have to focus on gathering up all of the records needed to fight back on the denial. This is not as easy as making a phone call or sending an email to the insurance company.

You might know that you are entitled to the file that the insurance company maintains on your ERISA claim. But getting your hands on the entire file is not easy. Your battle is not important to the disability insurance company, and its staff is in no particular hurry to get those materials in the mail for you.

Our ERISA appeal attorneys know from long experience that the insurance company representatives respond differently when a request for materials arrives from a disability lawyer. Their lack of compliance with an individual may not be a problem, but failing to respond in a timely manner to an attorney request is different, and they respond differently.

Those materials are extremely important for your ERISA appeal for several different reasons. They need to be reviewed to learn exactly what facts are being used (or misused) by the disability insurance company’s doctor or third party administrator to deny your claim.

The disability insurance claim file is also needed to prepare for the possibility of federal litigation if the ERISA appeal is denied at the administrative level. Frankel & Newfield does everything possible to succeed at this level, but we are also mindful of the need to prepare each matter for federal court. This gives us an advantage if the ERISA appeal should not go in our favor.

Frankel & Newfield requests and obtains disability ERISA files, practically daily, because we are familiar with the system and the pitfalls. Our years of experience focusing on ERISA appeals and disability insurance law give us another advantage: the disability insurance companies and their attorneys know us, our reputation for aggressively defending our clients and our tenacity. We don’t scare off, and we don’t go away.

Our preparation to battle a disability denial with an ERISA appeal includes digging into every single reason for the denial, rebutting each and every one of those reasons and destroying the foundation for the claim decision. We meet every single argument, and add more reasons why the claim must be paid.

Fighting an ERISA Appeal for a Disability Claim is Too Important to do on your own.

Going one-for-one with the insurance company while you are battling a disability that has left you unable to work, even if you are a high-functioning, high-earning professional, is simply not easy. We have represented many attorneys and executives—even insurance attorneys—who thought they would be able to develop a successful ERISA appeal on their own, but failed.

Your rebuttal evidence can and should include medical and vocational evidence, diagnostic testing where applicable, factual support from affidavits and support statements, and a pointed factual rebuttal, as well as support by medical literature describing the condition(s) at issue. This appeal may have a second audience - a Federal Judge - if the appeal is unsuccessful, to ensure that the ERISA appeal is ready to level up.

There’s more. If you do not restrict the scope of access you have provided to the insurance company, they will call your doctors during the appeal process, and potentially miscast a "peer to peer" discussion; thought should be given to requiring written contact only with claimant's doctors.

These are just a few of the things that go into an ERISA appeal from Frankel & Newfield.

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While the insurance company will often try to rush you through this appeal review, it is imperative that you appreciate the significance of this aspect of the process. It must comply with the time requirements, but it must also be prepared to win.

Before trying to handle an ERISA appeal on your own, call our office for a free evaluation of your situation at 877-LTD-CLAIM (877-583-2524) to learn how we can help.

Justin C Frankel

Written By:

Justin C. Frankel

Disability Insurance Attorney